Doctor flow reversed, as U.S. physicians move to Windsor

Dr. Christopher Blue is shown Friday, March 28, 2014, at his Windsor, Ont. office. Originally from Florida he is one of over 100 U.S. doctors to come to Windsor in the last decade. (DAN JANISSE/The Windsor Star)

The once-alarming outflow of doctors to the U.S. is now a beneficial inflow, with 105 physicians locating here from the States in the last decade.

“The job here is better,” is how Florida native Dr. Christopher Blue summarizes why he moved here in 2010 with his wife, Dr. Kristen Kupeyan (a Windsor native), after attending medical school in the Caribbean, and training in the United Kingdom and Michigan. Here, he works as a hospitalist, an emergency doctor and assists in surgeries at local hospitals, and has two practices with his wife. Having such a varied career is something he couldn’t do in the U.S.

“Health care in the States is changing dramatically,” said Blue, who has spent hundreds of thousands of dollars on his education but would have had a tough time recouping that in the U.S. where reimbursement isn’t what it used to be.

“As a practitioner here, you can literally rent out a place, hang up a sign and be full in a month.”

When it comes to how enjoyable it is to practise medicine, the two systems are going in opposite directions,” said Dr. Amr Morsi, a Canadian cardiologist who moved to Florida in 2001 because there weren’t many angioplasty facilities in Ontario at the time, and came to Windsor in 2008 to set up the city’s new angioplasty centre. The system in the U.S. is getting more difficult and frustrating, he said, citing the battles with hundreds of different insurance companies. “And the system here is getting better, to the point where a lot of physicians are looking across the border.”

Another American who’s set up a family practice here, Dr. Sajad Zalzala, said his initial impression of Canada was connected to billing caps and doctors leaving for the U.S. But a Canadian who was in residency with him in Michigan told him the situation was changed and when he got in touch with this region’s physician recruiter, Joan Mavrinac, she showed him that things were pretty good for doctors in Canada. One of the big draws for him was Canada’s system of universal health care. In the States, the health care system is like a class system, he said.

“If you have Blue Cross/Blue Shield (health insurance), you’re in great shape, you can go to what hospital you want, specialists, but that leaves everyone else not as fortunate,” he said.

Within a year of starting his Windsor practice in 2012, he had to stop taking new patients. Practising isn’t perfect here, he added. It’s sometimes tough getting patients in to see specialists quickly and some tests, like genetic testing, can take a long time.

But he has low overhead and fewer hassles. In the States, you need two or three staff just to fight with the insurance companies all day long, he said.

“It’s good. With the OHIP system you pretty much know how much you’re going to get paid as the patient leaves the room, as opposed to the States,” he said, explaining the insurance company may adjust your bill or reject it entirely.

Mavrinac said physicians in the States are lucky to recover 65 to 70 per cent of what they bill, compared to about 95 per cent here. Doctors also like the fact Canada is much less lawsuit-crazy. She said she talks to doctors in Windsor who’ve worked decades without being sued once. She talks to U.S. doctors “who have lost count.”

She said the flow reversed starting 10 years ago and since then 105 of the 375 doctors recruited here have come from the U.S. She’s recruited Canadians who trained in the U.S., medical school graduates of medical schools outside North America who did post-graduate residency training in the U.S., and born-and-bred Americans. Windsor gets so many Americans because it’s so close to Detroit (there are currently 16 physicians living in Michigan and working in Windsor, with two more on the way), and Mavrinac is a tremendous help at jumping through the many certification and immigration hoops.

Whether a doctor makes more here depends upon what the doctor does. Specialists who require hospital resources such as operating room time might not make as much as they would in the U.S. because local hospitals only have so much time to portion out, but other specialists and family doctors do quite well here, Mavrinac said.

“But beyond that, they like the patients, they like being able to treat their patients and not have that constant issue of, is this beyond their means,” she said, recounting stories told by U.S. doctors who want to order two or three diagnostic tests for a patient, but the patient can only afford one.

Being a doctor in the States can be “extremely frustrating,” said Dr. Charlotte Logan, a Detroiter who has worked in the emergency department at Windsor Regional Hospital’s Ouellette campus since 2012. When you’re an ER physician in the U.S., patients come in sicker because of lack of medical care, and you wonder what happens to patients with little or no insurance once they leave.

“In Canada, you don’t worry about that, they may not be able to get some medication you’d like them to have, but they can get the basics covered,” said Logan, who said she’s treated two gunshot wounds in two years in Windsor. In Detroit, she could treat two a day.

Since 2008, 36 per cent of the 213 doctors who’ve moved here have come from the U.S. But while the American recruits help with the local physician shortage, they haven’t solved it, Mavrinac said. The Windsor-Sarnia-Chatham health region called the Erie St. Clair LHIN has the lowest number of physicians for its population in the province. And the situation could worsen, since 20 per cent of practising family doctors are over 65 and 35 per cent are over 60. The Windsor-Essex region has about 650 doctors.

The lack of physicians was a big reason Dr. Syed Anees, a respirologist, and his wife Dr. Sabeen Anwar, a rheumatologist, came to Windsor from Connecticut last July, Anees said. They wanted to move to Ontario to be closer to family who had moved here, he said.

“We both thought we’d be able to contribute more than being in Mississauga or Toronto, where our family is.”

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